WHAT IS THE PICTURE EXCHANGE
COMMUNICATION SYSTEM, OR PECS?

By Beverly Vicker

Description of the PECS program
as defined by Lori Frost and Andrew Bondy

The Picture Exchange Communication System or PECS
approach is a modified applied behavior analysis program designed
for early nonverbal symbolic communication training. It is not a
program designed to teach speech, although the latter is encouraged
indirectly and some children begin to spontaneously use speech while
enrolled in the PECS program. The PECS training program was developed
at the Delaware Autistic Program. PECS training occurs during typical
activities within the natural settings of the classroom and the
home. The communication training occurs within a broader positive
behavioral support context entitled the Pyramid Approach. Training
techniques include strategies such as chaining, prompting/cuing,
modeling, and environmental engineering. (See the training manual,
video, and other print material published by Lori Frost and Andrew
Bondy for details about the program.)

Professional training regarding PECS is required
in order to implement the program as designed. Generally the training
is provided at a two-day workshop. While speech pathologists might
be the primary PECS program coordinator for a specific child, it
is helpful to have others also attend the two-day trainings since
they too will play an important role. These others could include
parents, the classroom teacher, and classroom assistants. They will
be important in identifying new vocabulary and may help construct
some of the picture display symbols as well as provide the nonverbal
individual with opportunities to use/learn the new vocabulary. Although
many people receive their initial training from a Pyramid Educational
Consultant, others may receive their training through a train-the-trainer
model from a local individual who has had training beyond the two-day
orientation and is certified to train others.

Who is a candidate for PECS training?

PECS training is not limited by age but rather
by a small set of criteria. Thus, PECS training could be offered
to a fifty year old adult with a cognitive impairment as well as
to a two year old with no cognitive impairment.

First of all, the candidate for PECS training should be an intentional
communicator. This means that the child (or adult) is aware of the
need to communicate his/her message to someone, even if it is in
a limited fashion. The child (or adult) who drags someone across
the room to the location of an object that he or she wishes to have,
has at least a beginning notion of intentionality. The child (or
adult) who attempts to obtain things without visually checking for
an adult or involving him or her in some fashion in the quest to
fulfill a desire or need, may not be intentional and may need a
different approach before PECS training. (See McLean, McLean, Brady,
and Etter, 1991 for information about contact and distal gestures.)

Second, the individual should have some personal preferences, in
addition to having intentionality. PECS helps to teach the concept
of the power of alternative communication. If one has no or weak
preferences, then it may be more difficult to understand and learn
the POWER of effective alternative communication via the PECS approach.
Sampling for preferences is a first step before beginning PECS training.
It may be necessary to develop a repertoire of preferences and dislikes
through trial and error or through a history of exposure to various
types of food, objects, or activities when there are few strong
preferences. (See Reichle, York, and Eynon, 1989 for additional
information on identifying preferences.)

Picture discrimination ability is not a pre-requisite criterion
for candidacy. Those individuals who do have discrimination skills,
may make faster progress in the initial stages of the program. Some
individuals, however, may spontaneously demonstrate that they not
only have the ability to discriminate pictured material but that
they also already know how to use pictures to communicate. These
individuals might be locating and bringing pictures or catalogues
on their own initiative to parents or teachers to indicate their
desires, for example. These children (or adults) may be ready to
begin more traditional augmentative programming; the latter would
allow a greater variety of message generation during the initial
stages. (See Beukelman and Miranda, 1998 for more specific guidance
regarding augmentative communication.)

Although the PECS strategy is primarily used with individuals who
are nonverbal, it could be used with individuals who are primarily
echolalic, those who have unintelligible speech, and those who have
only a small set of meaningful words or signs in their repertoire.
Careful consideration of the program and its strengths and weaknesses
should play an important role in program selection for each prospective
communication learner.

What is the PECS training format?

PECS Phase I

Programming for PECS begins with three people
in the training situation, the child (or adult) who will be transmitting
a message, the person who receives the message (e.g., Mom or the
teacher), and the facilitative adult who deliberately assists the
message sender to make the targeted response.

In Phase I, the program begins with enticement
whereby the adult displays or shows a preferred object or food item
to the child (or adult learner). As he or she reaches for the desired
object, the facilitator assists the child to pick up a picture for
the desired object or food item. He or she is physically assisted
to give the picture to the message receiver who must be physically
near the child (or adult ) communicator. The physical closeness
allows the exchange to easily take place. The adult who receives
the message (picture) does not say anything until the picture is
offered. At that juncture, the message receiver says something such
as “Oh, you want a pretzel (or whatever the picture represents)
and gives the item to the person making the request. In Phase I,
there is variation of the items requested, the person who receives
the message, the facilitator, and the environment in which the exchange
takes place. The objective is to have approximately 80 exchanges
during the course of the day.

PECS Phase II

In Phase II, the exchange continues with attempts
to increase the independence of the student. The facilitator is
still available for as-needed assistance. The student learns to
remove the picture from a display board for the exchange. He or
she must engage in more physical movement than in Phase I in order
to accomplish the exchange. It is preferable to have the child or
adult who is the PECS user be responsible for carrying his or her
own communication book.

PECS Phase III

In Phase III, the student learns to select the
target picture from a choice of multiple pictures that differ in
various dimensions. Error correction strategies are used when the
response is incorrect.

PECS Phase IV

In Phase IV, the student combines the object picture
with the carrier phrase “I want” on a sentence strip and gives the
strip to the adult or communication partner.

PECS Phase V

In Phase V, the student learns to respond to the
question “What do you want?” by exchanging the sentence strip. Use
of the questioning phrase is delayed until Phase V, because the
exchange behavior should be automatic by that point in the programming
sequence. Earlier use of the carrier phrase or an extended hand
gesture is believed to provide undesirable cues relative to the
desired behavior.

PECS Phase VI

In Phase VI, the student learns to respond to
the questions “What do you want?” vs. “What do you see?” vs. “What
do you have?” This last phase is designed to introduce the young
communicator to commenting behavior; the previous stages focused
on requesting behavior.

What types of symbols should be used for PECS training?

The pictures used with the program may be photographs,
colored or black and white line drawings, or even tangible symbols.
Mayer-Johnson pictures symbols, often called PCS, although often
used as stimulus material, are not a mandatory picture resource
for the program. Selection of picture representation type and size
is dependent on individual needs. (See the IRCA article entitled
Visual Resources for Enhancing Communication for Persons with Autism
Spectrum Disorders and Other Disabilities which is located on the
IRCA website for a listing of options.)

it necessary to follow the total PECS protocol?

Published reports regarding PECS are based on
implementation of the program as defined above. The program may
take several months or several years to complete. Not everyone who
says that he or she is using PECS is running the program as designed,
however. Some may use the strategy of a picture exchange but do
not adopt the PECS procedures and phases.

Many people try to run the program without using
a facilitator in the early stages. The latter would not be considered
as representing PECS programming, although it might be very successful
with selective individuals. Following the protocol for the first
three stages and then shifting to a more traditional AAC intervention
program, however, is recognized by Frost and Bondy as a legitimate
adaptation of the PECS program.

summary of PECS

PECS can be an effective program to assist specific
individuals with Autism Spectrum Disorders to become more effective
communicators. Decisions about the use of the PECS program, any
modifications of it, co-programming, or preliminary programming
must complement and reflect the needs of the individual emergent
communicator and should be made by the entire treatment/instructional
team.

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